Hypertension and Heart Failure Flashcards
Essential (primary) type I hypertension
Benign. Most common, slow progression, asymptomatic. Leads to CAD, cardiac failure, CVAs, renal failure, and peripheral vascular disease.
Essential (primary) type II hypertension
Malignant. Quickly induces heart failure, edema, and cerebral/renal damage.
What are the 7 types of secondary hypertension?
Renal artery stenosis, renal disease, Conn’s syndrome, pheochromocytoma, pre-eclampsia toxemia, hyperthyroidism, Cushing’s disease
Which is more prevalent, primary or secondary hypertension?
Primary (90-95%)
Which organ is involved in the maintenance of chronic hypertension?
kidneys
What is the primary pathology of primary hypertension?
Increase in TPR, increase in CO, and/or, increase in blood volume
Pump-based Hypertension
Increase in CO. Occurs in younger patients, amenable to beta blockers
Vascular Resistance-based Hypertension
Increase in TPR. Smooth muscle is abnormally sensitive to vasoconstrictors. Seen in older patients.
Volume-based Hypertension
Increase in retentions of sodium and water. Renal parenchyma disease, renovascular disorders. Failure of the RAS to regulate BP
Why is blood volume increased in HPT?
you need a higher arterial pressure to excrete sodium and water, requiring a higher blood volume
Baroreceptors
Baroreceptors modulate moment to moment changes in BP, and are not involved in long term regulation.
Peripheral vasodilators
decrease TPR
Diuretics
Decrease ECF and therefore BP
ACE Inhibitors
Decrease angiotensin II, and decrease vascular tone and ECF volume
B adrengeric blockers
Decrease CO and therefore BP
Syncope
Sudden and transient loss of consciousness due to a fall in BP, resulting in reduced cerebral perfusion
Postural Hypertensions
Physiologic peripheral vasoconstriction on standing in impaired resulting in hypotension
Cardiac Syncope
mechanical cardiac dysfunction or arrhythmia
Neurocardiogenic Syncope
Abnormal autonomic reflex causes bradycardia and/or hypotension
What are the clinical features of congestive cardiac failure?
Exercise intolerance, breathlessness (dyspnea), fatigue, peripheral edema
What type of failure is heart failure?
Left ventricular failure, which can lead to right ventricular failure
What are the three factors that affect stroke volume?
Contractility, preload, after load
What happens in systolic failure?
Decrease in contractility leading to a decrease in stroke volume (starling curve shifts down and to the right)
What happens in diastolic failure?
failure in filling (mitral stenosis) which leads to decreased EDV and decreased SV
